Homelessness is a complex social issue that impacts not only an individual’s living conditions but also their overall health. As the homeless population continues to grow, particularly among older adults, the need for medical respite care has become more pressing. Medical respite care is a short-term residential service for people experiencing homelessness who are too ill or frail to recover on the streets but are not sick enough to require hospitalization.
This innovative form of care allows homeless individuals to receive medical attention, rest in a safe environment, and receive support for long-term health issues while also working toward finding permanent housing.
Key Takeaways
Medical respite care is a critical component in addressing homelessness and health inequities by providing short-term residential services for homeless individuals who are too ill or frail to recover on the streets.
- The number of medical respite programs has surged in the past decade, with over 130 programs now present in 37 states and Washington D.C., driven by the increasing number of aging and deteriorating health among homeless individuals.
- Medical respite care provides a safe space for homeless individuals to recover from illnesses, surgeries, or injuries, helping prevent homelessness from exacerbating health issues and giving them a better chance of returning to stable housing.
- A comprehensive approach that combines medical respite care with long-term housing solutions, support groups, and training is necessary to truly address the issue of homelessness and health inequities in America.
The growing need for medical respite care
The number of medical respite programs across the United States has surged in the past decade, with these programs now present in 37 states and Washington D.C. Christ House in Washington D.C. was one of the first facilities of its kind, and today, over 130 similar programs are providing essential services to homeless individuals.
The rapid expansion of these programs is driven by the increasing number of homeless people, many of whom are aging and experiencing deteriorating health. Research shows that homeless individuals in their 50s are often in worse health than those in their 70s who have stable housing.
Half of all homeless adults are now over 50 years old, and the health disparities are stark. These individuals frequently face chronic conditions, infections, and physical injuries that make it impossible for them to recover on the streets.
The rise in medical respite programs is a response to these growing health concerns. Medical respite care provides individuals with an opportunity to recover from illnesses, surgeries, or injuries in a supervised setting where medical professionals are available to monitor their progress. This care is crucial because it helps prevent homelessness from exacerbating health issues, giving individuals a better chance of returning to stable housing and gaining access to proper medical care.
Diversity in medical respite programs
Medical respite programs vary widely depending on location and available resources, but they all share a common goal: to provide homeless individuals with the care and environment necessary for recovery. The most common setting for medical respite is a homeless shelter, where a few beds or a designated room are set aside for individuals who need medical attention. A nurse may visit once a day to check on patients, but these facilities typically lack round-the-clock medical care.
On the other end of the spectrum, some medical respite centers, like Christ House, operate as fully equipped facilities with medical exam rooms, social spaces, and full-service kitchens. These centers offer more comprehensive care, including 24-hour medical staff and access to a variety of social services, including support groups for individuals recovering from illnesses or undergoing treatment.
This level of service is often necessary for homeless individuals who are recovering from significant medical procedures or those with chronic health conditions.
While there are clear differences between programs, the goal remains the same: to ensure that individuals experiencing homelessness can receive the care they need to heal and eventually transition back to a more stable living environment. The flexibility in these programs is critical, as it allows for a range of care levels to meet the diverse needs of individuals experiencing homelessness.
Additionally, some programs incorporate training to help homeless individuals build skills that will support them in their journey toward long-term stability and independence.
Medicaid and managed care: A vital source of funding
The expansion of medical respite care is largely driven by managed care organizations (MCOs) overseeing Medicaid. The Affordable Care Act’s Medicaid expansion allowed more homeless individuals to access Medicaid-funded respite programs. As a result, MCOs began investing in these programs to reduce hospital readmissions, emergency visits, and healthcare costs.
Research shows that medical respite programs can save money in the long run. For example, in Washington D.C., MCOs like AmeriHealth Caritas DC partnered with local groups to create facilities like Hope Has a Home, which opened in 2019. The program has helped dozens of homeless individuals recover after surgery, improving health outcomes and reducing unnecessary healthcare costs.
While early data shows medical respite programs reduce hospital readmissions and emergency visits, the full financial impact remains uncertain. Limited studies and a lack of randomized controlled trials make it challenging to definitively assess long-term savings.
Barriers to expansion: Policy and funding challenges
The growth of medical respite care faces significant barriers, primarily in funding and policy. Medicaid typically does not cover “room and board,” which limits reimbursement for many programs, despite their clear benefits. This policy challenges consistent funding for respite care services.
Some states, like California, have secured waivers from CMS to cover respite care, offering a model for other states. However, this is not widespread, and many states still struggle with Medicaid reimbursement for these services.
While medical respite care aids recovery, it is not a solution to homelessness. As Julia Dobbins notes, “Medical respite care is not housing.” About 40% of those discharged from medical respite programs return to homelessness due to the lack of affordable housing.
The future of medical respite
The future of medical respite care will depend on both policy changes and an integrated approach to homelessness that combines healthcare, housing, and social services. While medical respite programs are critical for addressing the immediate health needs of homeless individuals, they cannot solve the problem of homelessness on their own.
As Dobbins emphasizes, “We cannot underestimate how sick people are.” Homeless individuals face complex and ongoing health issues, and without stable housing, the benefits of medical respite care are often short-lived.
In the long term, the focus must shift toward policies that address both the healthcare and housing needs of individuals experiencing homelessness. Housing First, a model that prioritizes providing permanent housing before addressing other issues like addiction or mental health, is effective in reducing homelessness and improving health outcomes.
By combining housing solutions with medical respite care, we can create a more holistic approach to ending homelessness and improving the well-being of vulnerable populations.
In addition, incorporating training programs into medical respite care can further support individuals in their transition from homelessness. These programs could focus on life skills, job readiness, and financial literacy, empowering individuals with the tools they need to maintain stable housing and improve their overall quality of life. With adequate support and resources, medical respite care can serve as a stepping stone toward independence and long-term stability.
Policymakers, healthcare providers, and advocates must work together to ensure that medical respite care becomes a standard part of the healthcare system for homeless individuals. Although the path forward is difficult, the increase of medical respite care programs and the growing awareness of the need for stable housing provide optimism for a future where homelessness no longer obstructs health and well-being.
Integrating medical respite and housing solutions
Medical respite care plays a crucial role in improving the health outcomes of homeless individuals, providing them with a safe space to recover from illness, surgery, or injury. The increasing availability of medical respite programs throughout the U.S. highlights the essential role these services play in addressing a critical need. However, challenges remain, particularly regarding funding and the lack of affordable housing.
To truly address the issue of homelessness and health, we need a comprehensive approach that combines medical respite care with long-term housing solutions, support groups, and training. Only by addressing both the immediate health needs and the systemic barriers to stable housing can we create a more equitable and effective response to homelessness in America.
